Business Credit Account No Personal Guarantee - PDF

							                                                                   APPLICATION FOR AN
                                                                   ACCOUNT AND PERSONAL
                                                                   GUARANTEE OF PAYMENT
              232 South Bridge Street ~ Elkton, Maryland 21921
                  Phone: 410-398-7670 ~ Fax: 410-398-7094      Credit is subject to approval upon receipt of
                                                                   completed application. Please allow 30 days!

________________________________________________________________________________
Company Name
________________________________________________________________________________
Address
________________________________________________________________________________
Billing Address (if different from above)
_____________________________________                      _____________________________________
Business Phone                                             Business Fax


COMPANY OFFICERS:
________________________________________________________________________________
Name                                  Title                Home Phone
________________________________________________________________________________
Name                                  Title                Home Phone
________________________________________________________________________________
Name                                  Title                Home Phone

BUSINESS INFORMATION:

Amount of Credit Desired: ________________                 How Long in Business: __________________
Type of Business: _______________________                  Is Purchase Order Required: ______________
Is this business:            ___ A Corporation             ___ Partnership                ___ Single Owned
If Single Owned, please list Social Security Number: ______________________________________
If Corporation, please list Federal I.D. Number: __________________________________________
List other names under which the company operates: _____________________________________


BANKING INFORMATION:
Banking Institution # 1: ______________________________________________________________
Address: _________________________________________________________________________
___ Checking                                        ___ Savings                                   ____ Loan
Banking Institution # 2: ______________________________________________________________
Address: _________________________________________________________________________
___ Checking                                        ___ Savings                                   ____ Loan
CREDIT REFERENCES:
Credit Reference Name # 1: __________________________________________________________
Address: _________________________________________________________________________
Phone: _____________________________________                                Fax: ____________________________
Credit Reference Name # 2: __________________________________________________________
Address: _________________________________________________________________________
Phone: _____________________________________                                Fax: ____________________________
Credit Reference Name # 3: __________________________________________________________
Address: _________________________________________________________________________
Phone: _____________________________________                                Fax: ____________________________
CREDIT CARD VERIFICATION:
      ___ VISA/MASTERCARD                        ___ AMERICAN EXPRESS                               ___ DISCOVER
Credit Card Number: __________________________________ Expiration Date: ________________
Card Billing Address: _______________________________________________________________
Your credit card is used for credit reference and must be kept current in order for your account to
remain open. Your card will not be processed unless prior approval is received.



                                              PERSONAL GUARANTEE
 In consideration of the extension of credit by the Seller herein, to Buyer herein, the undersigned does jointly and
 severally personally guarantee to pay and be responsible for payment of all sums, balances and accounts due Seller
 by Buyer, including collection charges and/or attorney’s fees. This shall be an open and continuing guarantee and
 shall continue in force not withstanding any change in the form of such indebtedness, or renewals or extensions
 granted by Seller, without obtaining any consent thereto, and until expressly revoked by written notice from me/us to
 Seller. Any such revocation shall not in any manner affect my/our liability as to any indebtedness existing prior
 thereto. I/We hereby waive notice of the acceptance of this agreement, notice of default or non-payment and waive
 action required by any statue, against the buyer. No delay on Seller’s part in exercising any right hereunder, or taking
 any action to collect or enforce payment of any obligations hereby guaranteed, either as against the Buyer or any other
 person primarily or secondarily liable with the Buyer, shall operate as a waiver of any such right or in any manner
 prejudice Seller’s rights against me/us. If necessary, the credit card used for reference and supplied on this application
 can be used as a method of payment should the account fall delinquent and difficulty in collecting payment is
 experienced by the creditor. I/We agree that in the event of any default at any time by said Buyer, Seller shall be
 entitled to look to me/us immediately for full payment without prior demand or notice.

 SIGNED: ______________________________________________ (INDIVIDUALLY)                         DATE: _________________


 SIGNED: ______________________________________________ (INDIVIDUALLY)                         DATE: _________________
                     PRINCIPAL’S ONLY



If by the terms of sale, credit is extended to Buyer, Seller reserves the right to revoke credit if Buyer fails to pay for any
goods previously delivered when due or if in the judgment of Seller there has been a material adverse change in Buyer’s
financial condition and thereupon Seller shall have the right to demand payment or other assurance which it deems
adequate before shipment of any further goods.

                                                                                                                        999116